Healthcare Provider Details

I. General information

NPI: 1841292653
Provider Name (Legal Business Name): DAVID P. BERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BOILING SPRINGS RD SUITE 2400
SPARTANBURG SC
29303-4201
US

IV. Provider business mailing address

1330 BOILING SPRINGS RD SUITE 2400
SPARTANBURG SC
29303-4201
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-5312
  • Fax: 864-582-1935
Mailing address:
  • Phone: 864-583-5312
  • Fax: 864-582-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7904
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: